Preoperative multivariate prediction of morbidity after gastrectomy for adenocarcinoma

Background: Gastrectomy remains the only curative treatment for gastric can cer. However, surgical morbidity and mortality remains high. Our aim was to identify the risk factors that determine operative morbidity and mortality and to describe a simple method for preoperative stratification of morbidi ty outcome. Methods: Retrospective review of patients who underwent gastrectomy for gas tric cancer. Multivariate analysis was used to define risk factors for surg ical morbidity and mortality. Results: A total of 208 cases were included. Fifty-one episodes of operativ e morbidity and 19 surgery-related deaths were found. Operative blood loss (risk ratio [RR], 1.0012), serum albumin (RR, 0.42), extent of gastrectomy (RR, 2.8), lymphocyte count (RR, 0.999), and splenectomy (RR, 1.51) were th e most important risk factors for morbidity. However, location of the tumor , serum albumin level, and lymphocyte count were the most important preoper ative risk factors that determine the appearance of surgical complications. Receiver operating characteristic analysis of this model allowed definitio n of three risk groups in terms of surgical morbidity (11.8%, 28.5%, and 52 .4%, respectively). Conclusions: A new method for preoperative calculation of the probability o f surgical complications was developed. It must be validated prospectively and in different settings to be used in preoperative interventions designed to reduce that risk.